Do you mean flushing or locking? Flushing is with saline. Locking is with saline or heparin when accessed depending upon your policy. When de-accessing, you should use heparin and I have never seen any evidence to the contrary for this patient population. Lynn
I am referring to locking. Both the volume and the strength of heparin in peds patients under 1 year that are getting accessed 3 x per week. Our latest patient has a port volume of 0.2 mls. Thanks,
A total volume of 0.2 mL for the catheter, port body, and access needle and attached extension set? That sounds like it is too small of volume. For locking, you can try saline but I would not be comfortable with that in a child. Are you thinking that the hemophilia wold pose some problem with heparin use? Lynn
Why is this poor child being accessed 3x per week?! Why not just leave it accessed for 1 week at a time and secure it well? I don't understand why a hemophiliac's port would require a different locking protocol than anyone else. Curious to hear others' thoughts/data on this!
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
I was just informed that the hematologists feel there is a greater risk of injury and/or infection when leaving an implanted port accessed for their hemophilia patients. I am talking about patients requiring factor infusions every Monday-Wed-Friday. The expectation is that the port will not remain accessed, but will be re-accessed every M-W-F for the infusions. This really doesn't make any sense to me. I would think the patient is at greater risk with every access. I also think the patient would have some say in this as well. It sounds like this is physician preference, and not necessarily based on any evidence. Does anyone have any supporting studies or information that would support this?
BJ Emory, RN, CRNI
Director of Infusion
Personal Touch Home Care
It makes perfect sense to me. Are these active children or teens? What are the chances of that port access needle remaining in the right place so infusion can be given on M-W-F? This is why ports were invented, so the patient does not have to deal with the external component when there is no infusion going through it. Many people use ports for cyclic infusion of PN and stick themselves every day. A port body can withstand ~2000 punctures. A small port used for peripheral placement can withstand ~750 punctures. Ports have the lowest rates of infection of all VADs. I do agree that the patient must be involved with this decision and it should not be dictated by the physician alone. But if the patient wants to be free of the port needle between doses, I would not have any issue with that. Lynn
Do you mean flushing or locking? Flushing is with saline. Locking is with saline or heparin when accessed depending upon your policy. When de-accessing, you should use heparin and I have never seen any evidence to the contrary for this patient population. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
I am referring to locking. Both the volume and the strength of heparin in peds patients under 1 year that are getting accessed 3 x per week. Our latest patient has a port volume of 0.2 mls. Thanks,
Karen
A total volume of 0.2 mL for the catheter, port body, and access needle and attached extension set? That sounds like it is too small of volume. For locking, you can try saline but I would not be comfortable with that in a child. Are you thinking that the hemophilia wold pose some problem with heparin use? Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Why is this poor child being accessed 3x per week?! Why not just leave it accessed for 1 week at a time and secure it well? I don't understand why a hemophiliac's port would require a different locking protocol than anyone else. Curious to hear others' thoughts/data on this!
Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA
I was just informed that the hematologists feel there is a greater risk of injury and/or infection when leaving an implanted port accessed for their hemophilia patients. I am talking about patients requiring factor infusions every Monday-Wed-Friday. The expectation is that the port will not remain accessed, but will be re-accessed every M-W-F for the infusions. This really doesn't make any sense to me. I would think the patient is at greater risk with every access. I also think the patient would have some say in this as well. It sounds like this is physician preference, and not necessarily based on any evidence. Does anyone have any supporting studies or information that would support this?
BJ Emory, RN, CRNI
Director of Infusion
Personal Touch Home Care
It makes perfect sense to me. Are these active children or teens? What are the chances of that port access needle remaining in the right place so infusion can be given on M-W-F? This is why ports were invented, so the patient does not have to deal with the external component when there is no infusion going through it. Many people use ports for cyclic infusion of PN and stick themselves every day. A port body can withstand ~2000 punctures. A small port used for peripheral placement can withstand ~750 punctures. Ports have the lowest rates of infection of all VADs. I do agree that the patient must be involved with this decision and it should not be dictated by the physician alone. But if the patient wants to be free of the port needle between doses, I would not have any issue with that. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861